title: A multicenter, randomized trial of a nurse-led, home-based intervention for optimal secondary cardiac prevention suggests some benefits for men but not for women: the Young at Heart study.
abstract: BACKGROUND
  We examined the impact of a prolonged secondary prevention program on recurrent hospitalization in cardiac patients with private health insurance.
  
  
  RESULTS
  The Young at Heart multicenter, randomized, controlled trial compared usual postdischarge care (UC) with nurse-led, home-based intervention (HBI). The primary end point was rate of all-cause hospital stay (31.5±7.5 months follow-up). In total, 602 patients (aged 70±10 years, 72% men) were randomized to UC (n=296) or HBI (n=306, 96% received ≥1 home visit). Overall, 42 patients (7.0%) died, and 492 patients (82%) accumulated 2397 all-cause hospitalizations associated with 10,258 hospital days costing >$17 million. There were minimal group differences (HBI versus UC) in the primary end point of all-cause hospital stay (5405 versus 4853 days; median [interquartile range], 0.08 [0.03-0.17] versus 0.07 [0.03-0.13]/patient per month). There were similar trends with respect to all hospitalizations (1197 versus 1200; P=0.802) and associated costs ($8.66 versus $8.58 million; P=0.375). At 2 years, however, more HBI versus UC (39% versus 27%; odds ratio, 1.67; 95% confidence interval, 1.15-2.41; P=0.007) patients were assessed as stable and optimally managed. For women, HBI outcomes were predominantly worse than UC outcomes. In men, HBI was associated with reduced risk of cardiovascular hospitalization (adjusted hazard ratio, 0.68; 95% confidence interval, 0.46-0.99; P=0.044) with less cardiovascular hospitalizations (192 versus 269; P=0.054) and costs ($2.49 versus $3.53 million; P=0.046).
  
  
  CONCLUSIONS
  HBI did not reduce recurrent all-cause hospitalization compared with UC in privately insured cardiac patients overall. However, it did convey some benefits in cardiac outcomes for men.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry Unique Identifier: 12608000014358. URL: http://www.anzctr.org.au/trial_view.aspx?id=82509.
authors.affiliation: Preventative Health and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.forename: Yih-Kai
authors.initials: YK
authors.lastname: Chan
authors.forename: Alicia
authors.initials: A
authors.lastname: Calderone
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
authors.forename: Stan
authors.initials: S
authors.lastname: Goldstein
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D064646:Cardiovascular Nursing / Q000191:economics; D016009:Chi-Square Distribution; D017046:Cost Savings; D018572:Disease-Free Survival; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D006701:Home Nursing / Q000191:economics; D017721:Hospital Costs; D006792:House Calls; D006801:Humans; D007348:Insurance, Health; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D017149:Private Sector; D015397:Program Evaluation; D012017:Referral and Consultation; D055502:Secondary Prevention / Q000191:economics / Q000379:methods*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: follow-up studies; heart diseases; prevention and control